Is Your Chest Pain Due to a Heart Attack? A New Protocol May Give the Answer


The HEART Pathway protocol is a faster method of identifying patients with acute chest pain who can safely be sent home from the emergency room without undergoing comprehensive cardiac testing, say researchers at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

The Wake Forest researchers evaluated electronic health records and insurance information for 8,474 adults who visited three different hospital emergency rooms with acute chest pain — 3,713 before the HEART Pathway was implemented and 4,761 after. The protocol identified 30.7 percent of the patients in the study as low-risk. During a 30-day follow-up, just 0.4 percent of these patients suffered a heart attack or died from any cause.

In the HEART Pathway protocol, four components are assessed to produce a numerical score:

  • the patient’s history
  • electrocardiogram (EKG or ECG) reading
  • age
  • risk factors

That score is then combined with the results of two blood tests done three hours apart measuring troponin, a protein released when heart muscle is damaged.

Results of the Wake Forest study, published in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association, suggest that, compared to usual care, this diagnostic tool resulted in a:

  • 6 percent reduction in hospitalizations
  • significant decrease in average hospital-stay length
  • substantial decrease in the amount of stress testing and coronary angiography

Sourced from: Circulation